PRIVACY: Benefits, Pitfalls of ‘Too Much Information’
The current dispute over medical privacy legislation "illustrates the potential benefits and dangers of trying to use medical information in new ways" and highlights why it has been so difficult for lawmakers to arrive at a consensus, the Washington Post reports. Many health care organizations have implemented or are implementing new features of their businesses that are dependent upon electronic patient records. Kaiser Permanente this fall will allow all members to make an appointment, ask nurses for advice and refill prescriptions online. Soon, the HMO "expects their online service to relay patients' laboratory test results via special e-mail accounts." Aetna U.S. Healthcare reviews patient records to find candidates for its disease management programs, which offer special services according to patients' conditions.
Can't Have It Both Ways
Aetna Chief Medical Officer Arthur Leibowitz said, "If society were to decide that we could never have access to a patient's records, that would be okay, as long as society doesn't also then hold us responsible for ... helping people get better care." Merck-Medco Managed Care reviews records and "without telling [the patient], routinely writes doctors urging them to consider switching the patient to a similar but less expensive medication -- or to stop prescribing a drug that the patient has been taking for longer than standard medical guidelines recommend." But civil liberties advocates warn that such information may be turned against patients. For example, the ability to test for genetic predispositions to diseases opens employees to "possible discrimination in getting health insurance or jobs."
What, Me Worry?
Based on anecdotal evidence, it appears that some patients are uncomfortable with new uses of their records. One in six "have taken steps to protect the confidentiality of their medical information," according to a survey earlier this year by the California HealthCare Foundation. Washington, DC, internist Peter Basch "said patients routinely ask him to use an alias when sending blood samples to a lab for an AIDS test, or not to submit claims for such tests to their health plans." But the recent experience of Maine indicates that the public does not want protections that are too ambitious. Gordon Smith, a member of the Maine Medical Association who helped write the Maine law, said, "What we really did ... (is) protect patients more than they wanted to be protected." The end result of the controversy, the Post notes, is "that some constituencies inevitably will end up dissatisfied." Robert Gellman, a consultant on confidentiality issues, said, "This privacy stuff is its own little monster" (Goldstein, 8/23).